Licensed therapists only
Where kindness meets healing.
PRP Referral Form
This form is for licensed therapists referring a current client to KindMind’s Psychiatric Rehabilitation Program for housing, employment, daily living skills, and after-school therapeutic mentoring. Family members and clients seeking services should visit our Get Started page instead.
This form collects Protected Health Information (PHI). Please complete it only on a private, secure device. Submissions are transmitted and stored on HIPAA-compliant infrastructure. KindMind Center, a service of Empowerment Therapy Services of Maryland, LLC, maintains a Business Associate Agreement with our form provider.
To be completed by the referring licensed therapist
Refer a client to KindMind PRP.
By submitting this form you confirm you are a licensed mental health professional with an active therapeutic relationship with the client named below. Required fields are marked with a green dot.
Coming Soon
Questions about a referral?
We're happy to talk it through.
Call us at 410.989.7538 ext. 2 or email <span style="font-weight:bold" [email protected] and our intake team will get back to you.